by Neil Bauman, Ph.D.
A lady wrote:
Would you explore the question of medications that affect hearing loss. My hearing gets noticeably worse every year. I’ve asked my doctor about which of my many medications (I’m 81) might cause deterioration of my hearing. He doesn’t seem to know.
Here is the list of what I am taking.
Ventolin HFA inhaler (Albuterol)
Vytorin (a combination of Ezetimibe and Simvastatin)
Klor-Con (Potassium chloride)
Vitamin D3, 2000 unit
Calcium+D 500mg
Veramyst nasal spray (Fluticasone)
Pataday eye drops
Lisinopril
Warfarin (Coumadin)
Advair diskus (Fluticasone)
Omeprazole (brand name Prilosec)
Fosamax (Alendronate)
Furosemide (Lasix)
Claritin
Centrum Silver
Tylenol Arthritis Pain
Tylenol PM
It can be hard to pin down exactly what is causing your hearing to drop each passing year. There could be any number of factors including aging and various health issues in addition to the drugs you are taking.
However, when I looked at the above list of drugs and vitamins you are taking, one drug instantly jumped out at me.
First, the good news. Of the 17 things you are taking, 16 of them are not known to cause hearing loss. (Some of these cause other ototoxic side effects such as tinnitus or vertigo so they can still damage your ears, but they are not known to cause hearing loss.)
Now for the bad news. One drug is well-known for causing hearing loss, namely Furosemide (brand name Lasix).
Your doctor has no excuse for not knowing that Furosemide is ototoxic because it has been known to cause hearing loss for 39 years now! It’s not a secret. Furthermore, Furosemide is listed as being ototoxic in his PDR.
Incidentally, Furosemide causes hearing loss in about 6.4% of the people taking it. Furthermore, the greater the dose and the faster you take it, the greater the incidence and severity of the resulting hearing loss. For example, in one study, 67% of the people taking Furosemide at the rate of 25 mg per minute ended up with noticeable hearing loss.
I would not be at all surprised if you find that your progressive hearing loss is largely caused by the Furosemide you are taking. You should ask your doctor if you could take another diuretic instead. For example, if it will do the job, Hydrochlorothiazide is much less ototoxic than Furosemide and is not known to cause hearing loss.
Vytorin took my husbands hearing. He now wears hearing aides. Losing his hearing has made him very depressed!
Hi Cathy:
What proof do you have that Vytorin (Simvastatin) caused your husband’s hearing loss? I can’t find any authoritative sources that list hearing loss as a side effect of this drug. Vytorin does cause various balance problems though.
Was your husband taking any other drugs besides Vytorin? There could be other causes besides the Vytorin.
Regards
Neil
Dear dr
I received crestor for some time now I suffer from tinnitus for last 2 years.
I have to take stations can I take simvastatin instead
Hi Mohamed:
Rosuvastatin (Crestor) is quite a bit more ototoxic than Simvastatin. Quite a few people have hearing loss from taking it as well as tinnitus and balance problems.
Simvastatin is no reported to cause hearing loss, but some people still get tinnitus and other balance problems.
It appears that changing to Simvastatin would be a step in the right direction if you want to protect your ears and reduce your risk of tinnitus.
Cordially,
Neil
Dr. Neil,
Is Zetia (ezetimibe) a known ear antagonist? I know it’s rough on muscles & joints.
Hi James:
It’s a relatively new drug so I don’t have a lot of information on it yet. But so far, it is reported as causing tinnitus, ataxia, dizziness and vertigo in some people. At this point, I’m listing it as a Class 1 drug–mildly ototoxic.
Cordially,
Neil
Dr. Neil
Are any ingredients in Flonase ototoxic? And if so, to what degree? It really helps my sinus problems which is turn, takes the edge off my tinnitus. Thanks, -Chris
Hi Chris:
Fluticasone (Flonase) is ototoxic to some people. Numbers of people have reported things such as hearing loss, tinnitus, hyperacusis, dizziness, vertigo and ear pain from taking it, so you want to be careful Keep an eye out for he above side effects when you take it.
Cordially,
Neil
I am having the same symptoms (minus vertigo ). Diagnosis is atypical Meniere’s Disease. If Flonase is the culprit is there any chance the symptoms will go away if I stop taking it? Thank you!
Hi Jennifer:
Fluticasone (Flonase) can cause the symptoms of Meniere’s disease such as hearing loss, tinnitus, dizziness and vertigo. If this drug is causing these symptoms, then stopping it may make them go away. If there is no change in the symptoms, then probably it is not the Fluticasone.
If you do have Meniere’s (atypical or not), you would do good to be checked out by an upper cervical chiropractor and make sure your C1 and C2 vertebrae are in proper alignment–which is the fundamental cause of Meniere’s. You can read my article on this at http://hearinglosshelp.com/blog/atlas-adjustments-alleviate-menieres-disease/
Cordially,
Neil
Hi there, I don’t know if you are still answering questions on here. I was wondering if it is possible for one 25 mg dose of benadryl can be ototoxic or would you have to be on it for longer or higher dosages? I took one pill and the next day developed tinnitus with hearing loss and vertigo. I have gotten 3 shots of prednisone in that ear now and it is helping with the hearing loss and vertigo but so far has had no affect on the tinnitus. It is driving me crazy. The ENT and audiologist both doubt it could be the benadryl and think it was a virus that caused it and both are optimistic the tinnitus should clear up soon or at least become quieter.
Hi Steph:
Yes, I’m still answering questions for people.
I wouldn’t have expected a single dose of Benadryl to be so ototoxic that it would cause hearing loss, tinnitus and vertigo. It’s not impossible though if you are very sensitive to Benadryl, just highly unlikely.
Did you have any active virus in your body at that time–cold, flu, herpes, etc., etc.? If so then it could have been viral and just coincidental.
Typically tinnitus is associated with hearing loss and thus if your hearing comes back, you could expect your tinnitus to go away. Otherwise, your tinnitus may prove to be permanent.
All is not lost however as you can learn how to take control of your tinnitus so it won’t bother you. So you can still have a bright future ahead of you.
Cordially,
Neil
Hi, I had quite rapid hearing loss in my left ear occur shortly starting Singulair 7 months ago, now stopped. 3 ENT’s later, an allergy doctor and a brain scan (MRI), I still have no answers. drastic improvement has occurred for short periods with pressure change, flying, diving, altitude changes, etc. but nothing permanent. Now I have developed tinnitus as well! I take Flonase, prevastatin, 81mg aspirin and Losartan daily, can these be the culprit? Desperate for answers! Thanks, Rob
Hi Rob:
Montelukast (Singulair) can certainly cause hearing loss according to the number of reports received by the FDA for hearing loss resulting from taking this drug. Even more people have reported tinnitus. People have also reported a number of other ototoxic side effects including Eustachian tube dysfunction, feeling of ears blocked and ear discomfort. This could be related to your relief with pressure changes.
So you could explain your symptoms as side effects of taking Singulair. But you have complicated the scene by taking all these other drugs that have many of the same side effects.
Fluticasone (Flonase) has 3 times more reports of hearing loss, 2 times more reports of tinnitus than Singulair–hundreds and hundreds of people in each case. Reports of Eustachian tube dysfunction, ears blocked and ear discomfort are more or less the same for these two drugs.
Pravastatin (Pravachol) has roughly the same number of reports as Singulair–sometimes more and sometimes less–depending on the side effect.
Losartan (Cozaar) has about half the number of reports of hearing loss and tinnitus as Fluticasone, but the fewest reports of the other side effects mentioned above as compared to the other 3 drugs.
A baby aspirin a day likely won’t affect your ears unless you are unusually sensitive to aspirin.
So when it comes to tinnitus, Fluticasone is the worst, closely followed by Losartan, the Pravastatin with Montelukast bringing up the rear. When it comes to Eustachian tube dysfunction (the pressure changes) Fluticasone is again the worst, followed by Pravastatin and with Montelukast and Losartan way down bring up the rear.
This should give you a clue which drugs are likely responsible for your present tinnitus and continuing pressure problems. But who knows how they all act together, so you may have to get rid of two or more.
Cordially,
Neil
I suffer from vertigo every couple of months or so. Just suddenly wake up with it so bad I cannot move my head and I vomit.
One doctor asked if I had taken anything the night before and I mentioned taking Tylenol pm. Two different times before it occurre. Can Tylenol pm cause the vertigo? Meds I’m on are flutacosame, daily vitamins and metaprolol.
Hi Kim:
Acetaminophen (Tylenol) can indeed cause vertigo. In fact, more than a thousand people have reported to the FDA but they got vertical from taking Tylenol.
Metoprolol also causes vertigo in hundreds upon hundreds of people. So you have two drug possibilities. You might want to change the Metoprolol for a different beta-blocker drug that is not very ototoxic. My special report at http://hearinglosshelp.com/shop/the-relative-ototoxicity-of-anti-hypertensive-drugs/ lists various classes of anti-hypertensive drugs including the beta-blockers and gives you their relative ototoxic risk. It just so happens that Metoprolol is by far the most ototoxic drug in the beta-blocker class. It would probably be a good idea as far as your ears are concerned to find another beta-blocker that is not as ototoxic.
You could also get vertigo if you lay the wrong way and pinch your neck. If you have a sore or stiff neck that may be another possibility to consider.
Cordially,
Neil
Is Oxymetazoline ototoxic? Can it cause tinnitus?
Hi Alan:
Yes, it is somewhat ototoxic. It can cause tinnitus in a few people, but hyperacusis and dizziness are its two most common ototoxic side effects.
Cordially,
Neil
Is tinnitus caused by sprays containing oxymetazoline reversible?
And why is the tinnitus & hyperacusis not listed as a side effect?
Hi Alan:
I have no information as to whether tinnitus from taking Oxymetazoline is tempory or permanent.
They only list the more common side effects. Many drugs have 100 or 200 side effects, but you never see this complete list. There was one website that used to list the first 100 most common side effects but they took it down. Another website gave you the complete list and it too has disappeared. Don’t want to scare the “customers” away ya know.
Cordially,
Neil
Why do the regulatory bodies allow this? Prioritising Profits over safety information
for customers.
Thanks
Is Oxymetazoline the same chemical as xymetazoline hcl.
Hi Alan:
Yes, Oxymetazoline is the shortened form for Oxymetazoline hydrochloride (HCL). Some drugs have several forms of which HCL is one, but the active ingredient remains the same–namely in this case, Oxymetazoline.
Cordially,
Neil
what about ciclesonide (Omnaris)? also does the PH level in these nasal sprays impact their ototoxicity, since they do end up going up the middle ear ? because Flonase it is like a 6 PH, and Omnaris a 4.5. significantly loads more people use Flonase then omnaris, so guessing that that will also impact the numbers.
Hi Deen:
I have no information on pH and ototoxicity so can’t help you there.
I’m sure Flonase is used much more commonly than Omnaris–so consequently you’d expect far more ototoxic reports for Flonase–and that is exactly what happens. In fact, I have 158 TIMES as many ototoxic reports for Fluticasone (Flonase) than for Ciclesonide (Omnaris).
Now if you knew the number of prescriptions filled for each of these drugs last year, you’d have a good idea of which drug is the more ototoxic–just divide the number of Flonase prescriptions by the number of Omnaris prescriptions. If the number is less than 158, then Flonase is more ototoxic.
Cordially,
Neil
Can using nasal sprays cause hearing loss?
Hi Zedh:
I’m sure they can, but not telling me a specific drug means I can’t give you a specific answer.
Cordially,
Neil
Otrivine specifically.
Hi Zedh:
I don’t have any information indicating that Xylometazoline (Otrivine) is ototoxic, so it should not be causing hearing loss, tinnitus, etc.
Cordially,
Neil
Hi Neil,
I have some questions relative to the ototoxicity of some medications. I have mild tinnitus myself and does not want it to worsen…
First of all, I am thankful for what you do and how you help others. I see that you mention “fluticasone” as potentially ototoxic, however when I look into your 3rd edition of Ototoxic drugs, I see no clear mention of hearing loss or tinnitus as a side-effect, and I see “class 1” for the drug. Could you please detail why you say there can be tinnitus or hearing loss side effect? Is it because between the 3rd ed. of your book and nowadays, some reports started to appear?
Also, I’ve been very recently (3 days ago) diagnosed with “acute sinusitis” (not bacterial) and was given treatments such as Aerius (desloratidine), budesonide nasal spray and decongestant (acetaminophen, chlorphenamine and Phenylephrine).
As I am not a drugs-person myself, I decided to research and not to take the decongestant (potential ototoxicity and useless apparently) and do instead lots of nasal cleanings with saline water, aside from some essential oils. I took Aerius 2 days, seems like it had some effect (less pain in sinus), and had no effect at all on my tinnitus. I take twice daily the lowest possible dose of Budesonide (one spray morning, one spray evening) and same, no effect on tinnitus.
It’s actually the other way around, Budesonide and/or Aerius made my tinnitus disappear at some point I believe. My question is: sometimes I feel a bit of clogged ears, can take several minutes/hours before going back to “normal” sensation. Could this be a sign of ototoxicity and hearing loss? Or, does the fact that it comes back to normal after a while “prove” it’s not hearing loss-related?
I would like to know if continuing the treatment for a bit may be a wise option, given I don’t want this sinusitis to become chronic. Also, most websites say it goes by itself with time, and drugs just ease symptoms.
Thanks for your advice,
Damien
Hi Damien:
You are exactly right. Between the time I put out the third edition of my drug book (2010) and now I have discovered an enormous wealth of ototoxic information that I am slowly incorporating into what will be the 4th edition.This new edition will be an estimated 1,600 pages long! (Twice the size of the 3rd edition.)
The new edition will show that hundreds and hundreds of people have reported tinnitus and hundreds upon hundreds more have reported hearing loss from this drug. I have tentatively changed its drug class to a 3 from a 1.
Of the three drugs you are taking, Desloratidine has by far the fewest reports of ototoxicity, Budesonide is in the middle and Fluticasone is the worst.
I tend to think that your ears feeling clogged is because they are, not because of ototoxicity of the drugs. As the gunk drains out of your Eustachian tubes, your hearing returns and tinnitus goes away. I’m with you on treating things without drugs if it works for you–the saline solution. If you need some drug help, the Desloratidine seems to be helping you a bit and is by far the least ototoxic so you might want to keep on taking it for a few days.
Cordially,
Neil
Thanks Neil, I’m glad to read your answer 🙂 I’d love so much to have the 4th edition as soon as it comes out, when do you think you will release it?
Actually, I just came out from an ENT visit, and it turns out I still have lot of mucus coming out from my right sinus (got a fibroscopy).
The ENT recommended me to keep using Desloratadine for now as well as a Nasal spray called Otrivin. I didn’t see anything bad about these, and as you say, Desloratadine may be the safest option, so I’m not worrying.
However, the bad news for me is that if by Monday the treatment doesn’t solve the issue, he said I’d be good for antibiotics. He wants to prescribe a quinolone called “moxifloxacin “, though I’m wondering what you think of it? It’s officially “Class 2” in your book, and I read some bad comments on the web that I’m now so afraid to take it.
I’d like to advise my ENT to use another one. What do you think could work for sinusitis? I usually took Augmentin before without side effects. Worth giving it a try you think?
Thanks for your time.
Cordially,
Damien
Hi Damien:
It looks like it is still 2 years away. I don’t have much time to work on the drug book. First I need to finish a book I’m writing before I can give full attention to the drug book. And of course answering all these questions takes a lot of time too every day. That’s just the way it is.
Personally, I’d stay away from any of the fluoroquinolones, including Moxifloxacin, if at all possible. They are a nasty class of antibiotics–both for your ears and the rest of your body.
If you took Augmentin (Amoxicillin) before with no side effects, I’d say that would be a much better alternative–although Amoxicillin is itself ototoxic so you still want to be careful.
Cordially,
Neil
Hi Dr.,
About 11 days ago I woke up with my right ear feeling clogged. I saw an ENT on day 6 who, after a hearing test with the audiologist, said it’s likely moderate to severe hearing loss called sensorineural. He did order an MRI just to rule out anything else, which I haven’t had yet. He also put me on a short course of prednisone. I’m on day 5 of prednisone and still have the clogged feeling. And, worse, it feels like it’s partially in the other ear now too. I feel like I’m losing my hearing and I can’t do anything to stop it!
I was reading your posts and came across your comments about Flonase. I actually started taking Flonase at the end of April for sinus headaches. So now I’m wondering if my hearing loss could be from the Flonase. I’m definitely going to stop taking it.
What are your thoughts? Do you think if the Flonase caused my hearing loss, it could be reversible when discontinuing use? I really appreciate your time!
Thanks,
Karen
Hi Karen:
There have been hundreds upon hundreds of reports to the FDA that Flonase caused their hearing loss. So it is entirely possible that this is the cause of your hearing loss too.
Did you have any other side effects while on the Flonase such as dizziness or other balance problems?
I assume you have stopped taking the Flonase. If you notice your hearing coming back with the Prednisone, I’d say the Flonase probably was the culprit. Let me know how it goes.
Cordially,
Neil
My aunt has been on Warfarin for a year now, and now has tinnitus, vertigo, and hearing loss. Could it be because of Warfarin
Hi GD:
It could well be the case. Warfarin is reported to cause hearing loss, tinnitus and vertigo in hundreds upon hundreds of people. (and a bunch of other ototoxic side effects too). So if nothing else appears to be the culprit and these side effects began after she took the Warfarin, I wouldn’t be at all surprised if the Warfarin is the culprit.
Cordially,
Neil
i have severe meniere disease that accompanied by dizziness vomiting and fullness / pressure in my right ear that stays and drive me crazy also the dizziness and vomiting is severe i saw different doctors and did all kinds of treatment, i take Vytorin, vitamin D(5000) + K, vitamin C, DHA, COQ10, b12 and other vitamins does any of those drugs do meniere disease, what can i do
Hi Ida:
Taking all those vitamins and supplements is good (I take many of them daily too), but they are not going to fix Meniere’s, because a lack of them is not the cause of Meniere’s. And taking Simvastatin (Vytorin) in my opinion, is doing more harm than good as attested by thousands upon thousands of reports of ototoxic side effects resulting from taking this drug.
The underlying cause of Meniere’s, although doctors don’t know this (although they should) is your C1 and C2 vertebrae being out of proper alignment. The cure is simple–go to an upper cervical spine chiropractor (not a conventional one).
I wrote a comprehensive article on this subject that you can and should read. It is at https://hearinglosshelp.com/blog/atlas-adjustments-alleviate-menieres-disease/
Everyone that has Meniere’s and has followed this treatment and told me about it has had success. That is what I’d do if I had Meniere’s. And indeed, I began having incipient Meniere’s symptoms (periodic vertigo), so I went to one of these guys and with just two treatments, I’ve never had another “attack” in the past 4 or 5 years since I had the treatments.
It’s certainly worth investigating.
Cordially,
Neil
Hello Dr. Neil Baumann,
I’ve read your informative thread with great interest. You see, I’ve been experiencing gradually intensifying tinnitus for a couple of years now, and my wife is saying that I need hearing aides because apparently my hearing is getting worse too. And now I find myself getting dizzy at times. My doctor keeps prescribing medicine as I get bad sinus infections and asthma attacks without them.
I’ve been taking Flonase twice daily for 4-5 years, which I understand from your responses can be a likely culprit. I’ve also taken Advair for 4-5 years but now I’m on Breo, due to insurance coverage, and I’ve been taking Cetirizine once daily as well. This all due to bad allergies and asthma that started after I lived in an old house that had a hidden and quite hideous case of mold infestation. At any rate, if I can’t use Flonase, which nasal spray can I use that is less/not ototoxic? And should Breo and Cetirizine also be switched out? If so, what are my least ototoxic options? Thank you for the valuable information.
Best regards,
Oz
Hi Oz:
Hearing aids are a good idea if your wife can tell you have a hearing loss. I’ll bet it is quite significant in the higher frequencies and that really negatively affects how well you understand speech.
And incidentally, many people find that wearing hearing aids cuts the level of their tinnitus way down while they are wearing them. So you could kill two birds with one stone so to speak.
As you know, many drugs can cause both tinnitus and hearing loss, as well as balance problems, so the fewer drugs you take the better, and the lower the dose the better also.
Flonase is a brand name of the generic drug Fluticasone. Breo is a combination of Fluticasone and Vilanterol. So it is largely the same as taking Flonase.
Advair is a combination of Fluticasone and Salmeterol. So again, the main ingredient is still the Fluticasone.
Cetirizine (Zyrtec) and Fluticasone have about the same degree of ototoxicity but Cetirizine is a bit worse so its hard to know whether you tried to cut one out if it would make any difference to your tinnitus.
I don’t know which drugs would help you so you need to ask your doctor for other alternatives and then I could tell you their relative ototoxicity values.
What I’d do if I had a bad case of mold toxicity is to find an expert who has a proven record of helping people using a mold detoxification program.
Cordially,
Neil
Hi Neil, Can i ask you your opinion on Cetirizin, Aerius(desloratadin), Neo-mercazole, prednisone, ventoline, seretide-diskus(astma inhalers) and the potentially effect on the ear?
mild hearing loss, tinnitus, feeling of glogged ear and glogged sinus on one side, without any mucus, so it is like the eust tube(?) swells. I am a “hyper allergic” person and i really feel like my ear issues is due to allergy but i dont get any explanation from all of the doctors i have seen. I am also suspecting meniers..but i do not have any dizziness. This is all like a mystery to me! At the same time my tinnitus startet (april20) and i started noticing the feeling of my ear beeing clogged i was diagnosed with Graves. do you have any knowledge on Graves and ears? Can my medication have anything to do with this? I have been on allergy and asthma medications daily for 20+ years.. So grateful for your comments🙏
Hi Trude:
Cetirizine is mildly to moderately ototoxic and can cause hearing loss, tinnitus, balance problems, dizziness, vertigo, etc.
Desloratadine is only mildly ototoxic, but again can cause hearing loss, tinnitus, balance problems, dizziness, vertigo, etc., just that there are fewer reports on this drug.
Carbimazole (Neo-Mercazole) is very mildly ototoxic.
Prednisone is moderately ototoxic and could cause all your symptoms, but I don’t know how likely it would be in your case.
Albuterol (Ventolin) and Fluticasone (Seretide) are also moderately ototoxic and could be causing your side effects.
Why do you suspect you have Meniere’s? Three of the above drugs can produce Meniere’s-like side effects and, in fact, are (wrongly) listed as causing Meniere’s disease–but this is wrong because Meniere’s is caused by your C1 and C2 vertebrae being out of proper alignment. (For proof of this see my article on this subject at https://hearinglosshelp.com/blog/atlas-adjustments-alleviate-menieres-disease/ .
I’m not aware of Grave’s disease affecting our ears, but I’ve never specifically looked into it so what do I know?
In my opinion, Albuterol or Fluticasone are the most likely culprits for your ear symptoms.
Cordially,
Neil
Thank you so much for your reply! I suspect my ear symptoms has to do with my allergies as they clog and pops and feels worse now when the season has started. I also suspect food allergies.. I get so little answers from the different spesialists i have been seeing. I rarely use any nasal sprays but i have been taking a lot desloratadin over the years…I have switched to cetirizin now. Do you have any knowledge of allergies causing something in the ear to swell(that the ENT does not see)? I have read about meniers and i have mild hearing loss only in one ear also the same ear i have the tinnitus or buzzing in. I have some symptoms in the other ear as well but not at all the same. I have read that Meniers often is one side and this feeling of swelling.. It also gets worse if i am eating sugar, carbs, too much coffee, stress etc. I have been seeing chiropractors and one upper cervikal, some of them says i have a misaligned atlas and some of them says i do not have it. Do you have any knowledge of allergies and autoimmunity, innflamation and the ears? Would you recommend me to try a diet and quit my allergy med? So grateful again for your reply!
Hi Trude:
Allergies can cause your sinuses to clog up and sometimes clog up your Eustachian tubes/middle ear to some degree. This can give you a feeling of fullness or a blocked feeling in your middle ear. It also causes a temporary conductive hearing loss and temporary tinnitus. When the gunk drains and your ear clears, then the feeling should go away and hearing return to normal.
It is true that Meniere’s is almost always in one ear at a time. It normally has 4 symptoms when you get periodic attacks, of which a feeling of fullness in the ear is one. The other three are periodic episodes of vertigo, tinnitus and a fluctuating hearing loss. If you are not having periodic attacks with these symptoms then it’s not full-blown Meniere’s.
Does the upper cervical chiropractor say your Atlas is off? If so, did he properly align it? If not, why not?
I’m no expert on allergies, autoimmunity, etc. If you know your symptoms are made worse by eating/drinking certain foods, then in only makes sense to limit your intake of these foods. Allergies can be caused by leaky gut syndrome–and leaky gut syndrome is related to the foods you eat. So eating a diet that addresses leaky gut syndrome should also control your allergies if they are from that cause.
I’m all in favor of getting of drugs if you can by addressing the real cause of your allergies.
Cordially,
Neil
Dear Neil,
I’m sorry to bother you in this thread, but I don’t know where else to turn.
I’m 26 and Australian. It is early winter here. I’ve been having an absolutely terrible season for allergies, and have been using albuterol for a couple of weeks straight at the maximum permitted dosage (two puffs four times a day). I also started taking loratadine a couple of days ago.
I’ve suddenly developed a high-pitched ringing in my ears. I can’t tell whether it’s pulsing or not. I also feel as if I can’t hear things quite as clearly. It doesn’t seem to be responding to sublingual Vitamin B12, nor to clearing my ears with hydrogen peroxide.
It’s really distressing me. I’ve stopped taking the loratadine. Is it realistic to hope that if I stop taking the albuterol it will go away? I just want my hearing back 🙁
I apologise for the informality with which I opened my previous comment. I had a quick look and thought everyone was doing it, but I was very tired.
Thanks in advance if you respond!
Hi Isabelle:
Of the two drugs you are/were taking, the Albuterol is far more ototoxic than Loratadine according to my calculations by a factor of 6 times for causing tinnitus and by a factor of 10 for causing hearing loss. These are averages, and you may not be average.
Both of these drugs can cause hearing loss–so that could be the reason for the trouble hearing, but it could just be that your ears are clogged up because of your allergies–or some of both.
How long after you began taking the Loratadine did the tinnitus start? It could have been the Loratadine if the tinnitus started within a day or two. But it could have also been the combination of the two drugs acting together. And it also could have been the Albuterol–just that it doesn’t cause tinnitus right away.
Is there any other allergy drug you could take that would do the job rather than the Albuterol?
As for calling me Neil, no apology necessary. After all, it Is my name. You don’t have to add the “Dr.”–some people do and some don’t. It’s no big deal.
Cordially,
Neil
Dear Neil,
I’ve suffered from major congestion for most of my life and took no meds or over the counter medication for a long while. However, my aunt introduced me to nasal sprays and relied on them to be able to breath and sleep. I’ve tried to go to the doctor but all they offer is mucinex and other allery medicine. So unfortunately I’ve spent a good amount of time taking over the counter nasal sprays. Now recently I woke up with a ringing in my left ear and assumed it may be this nasal spray I got from Walgreems, it’s a store generic one. I’m wondering if my long term use of nasal sprays and or this new spray is contributing to my ringing in my ears. For context, I’ve cleaned it out of any exsses wax and and flushed it out with an ear cleaner however the ringing still persists. I take no other medications and generally take care of myself. Any insights on what may be causing the ringing and loss of hearing in my ear? I apreciate you taking the time.
The Nasal Spray in question is- Severe Afrin Nasal Spray, with the active ingredients as “xymetazoline hydrochloride 0.05%”
Hi Adam:
Taking Oxymetazoline (Afrin) can indeed result in tinnitus in some people. It probably doesn’t happen all that often, but to the people that get tinnitus from it, that’s small comfort.
Furthermore, any drug that causes hearing loss can also result in your getting tinnitus as a secondary side effect. Oxymetazoline can cause hearing loss in some people too. You don’t say which OTC drugs you took so I can’t speak to them.
Cordially,
Neil
Dear Dr. Neil,
My ENT prescriped me Flixonase nasal drops (fluticasonpropionaat) 400mcg for one month, two capsules daily.
As i understand from above this medicine is midly ototoxic and can cause tinnitus. I used one capsule 2 weeks ago and experienced light increase of my tinnitus. So i stopped. But yesterday i used one capsule again, because of the pressure feeling in my ear. Again increased tinnitus and panic (anxiety).
I called the ENT today en he says flixonase doesnt create tinnitus. 100% sure. And i should continu.
An other ENT however say it could be because its a steroid (prednison like). He said the tinnitus will diminish within a week, because i only used one dose. Otherwise it can take 4 weeks.
Do you agree that 1 or 2 doses will not have any permanent damaging effects? And the tinnitus side effect will go away.
After all the dose and time span makes a certain medication ototoxic.
Is Nasonex spray a better option instead of flixonase or avamys?
Would like to hear from you. Thanx!
Hi Johan:
If Fluticasone ( Flixonase, Avamys) is not ototoxic and doesn’t cause tinnitus why have hundreds upon hundreds of people reported hearing loss and tinnitus to the FDA’s database after taking this drug? This shows the great discrepancy between the drug company’s studies before the drug is released and the real world results. (It’s true that Fluticasone does not have hearing loss and tinnitus listed as side effects in the various drug books such as the PDR, etc. so if your doctor is just referring to them, then in his mind he is correct, but this does not reflect the real world situation.)
Based on the number of reports divided into the number of prescriptions written, Fluticasone (Avamys, Flixonase) is not as ototoxic as Mometasone (Nasonex). Avamys and Flixonase are the same basic drug–Fluticasone–just different brand names.
I don’t have any specific information on whether tinnitus is permanent or temporary. Typically, I’d say that 1 or 2 doses probably will not result in permanent tinnitus, but that needs to be tailored by your mental/emotional state. If you fixate and obsess over your tinnitus it could become permanent. However, if you basically ignore it and get on with your life, it should fade away in a couple of weeks to a couple of months.
Cordially,
Neil
Thank you Dr. Neil for your quick response as always. I will not use this medicine anymore. Probably tinnitus can also occur indirectly because this drug can induce anxiety and depression.
mental/mood changes (such as depression, mood swings, agitation), or
Now its time not to focus on the tinnitus, relax and going further. Have a good day!
Is Nasonex spray a better option instead of flixonase or avamys?
Hi Dr. Neil,
I just read through this thread. My husband has been on Fluticasone for around 10 years (seasonally). He just stopped taking it for the winter and immediatly developed a case of tinnitus. All the instances I have read above seem to suggest that tinnitus developed after starting Fluticasone. Has anyone ever had the opposite happen?! He has seen an ENT and a chiropractor and neither have much help to offer but his hearing is imaculate according to the ENT. The tinnitus is his only symtom so far (2 weeks in) except the anxity and sleeplessness caused by it. If the Fluticasone did cause it is it likely permanant? Any insight would be greatly appreciated as well any information regarding the FDA reported side effects you mention above about Flucticasone . Thanks!
Hi Heather:
I’ve never heard of anyone developing tinnitus as a result of stopping taking Fluticasone. However, this can and does occur when stopping various benzodiazepine drugs.
One possibility though, is if by stopping the Fluticasone, his ears clog up somewhat so that he has some degree of conductive hearing loss–and the tinnitus is a result of the hearing loss. If this is the case, then if his ear clear and hearing is restored, the tinnitus could disappear at that point.
If he now has a sensorineural hearing loss from the drug, or from aging, then the tinnitus could be a result of that hearing loss and would tend to be permanent.
He may have “immaculate” hearing in the lower frequencies–they only typically test to 8,000 Hz, but hearing extends to around 20,000 Hz and he could have hearing loss up there resulting in tinnitus. Thus, it is possible that the tinnitus occurring just after stopping the Fluticasone could be a coincidence.
I’d need more information about his situation to give a better idea of what might be occurring with his tinnitus.
Cordially,
Neil
Hi Dr. Neil,
Thank you for your previous response. So my husband is in his late 30s with no prior hearing loss but he has had a history of Eustachian tube dysfunction. He hasn’t been able to fly in 12 years because the last time he did the pressure was so excruciating he was sick. He has been taking flucticuzone longer than those symptoms and now the tinnitus. He has no other issues though…ear fullness or pain. We are at such a loss of what to do next. He did take doxycycline which I believe is an ototoxin but it was 3 months prior to the tinnitus starting. Not sure if there is a connection or I’m just grasping at straws? Have you come across successful cases of tinnitus treatment that were not hearing loss related? Or should go back to the ENT and get retested for the higher ranges you mentioned? Thank you so much for reading this!
Hi Heather:
Are you saying that your husband was taking Fluticasone BEFORE he got the Eustachian tube dysfunction? If so, about how long before?
When did his tinnitus start in relation to beginning to take the Fluticasone?
You (and he) may be interested to know that Eustachian tube dysfunction is one of the ototoxic side effects of this drug. So is tinnitus.
Another cause of Eustachian tube dysfunction is having your neck out of proper alignment such that the trigeminal nerve is pinched to some degree. This can occur if your C4 vertebra is not in proper alignment.
What I’d do if I were in his shoes is go to an upper cervical chiropractor (NOT a conventional chiropractor) and have him take precision xrays, etc. to determine if his cervical vertebrae are in proper alignment.
You can find these special kinds of chiropractors by going to http://www.upcspine.com/ and clicking on “practitioners”. These chiropractors do not manipulate and “crack” your neck. Rather, they precisely push the out of place vertebrae back into proper position using various techniques depending on which version of upper cervical chiropractic they have learned.
Cordially,
Neil
Thank you Dr. Neil. I am looking into the upper cervical chiro treatment you mentioned. Yes, my husband began taking Fluticasone prior to his issue with flying. We believed it to be Eustachian tube dysfunction due to the fact his ears do not pop when desending in an airplane even when trying all the regular tricks like taking decongestants, chewing gum, airplane ear plugs etc. Also He had tubes on several occasions as a child but had no prior issue with flying before college when he also started taking Fluticasone for allergies (that was over 10 years ago). Is ear damage from oxytoxins permanent?
Hi Heather:
There’s no guarantee that upper cervical will solve your husband’s ETD problem, but it’s where I’d start since other solutions haven’t worked.
Ear damage from ototoxic drugs may be permanent or temporary depending on a number of factors. If the drug causes sensorineural hearing loss, that is typically permanent. Tinnitus may or may not be permanent. Often middle ear problems can be fixed–again depending on exactly what is wrong.
Cordially,
Neil
Hi, I woke up 2 days ago and could not hear out of my right ear. My dr did a hearing tests and said it my hearing is fine and it was just sinus related. He put me on Fluticasone propionate for sinus pressure and its only been a day and its already helped. After reading all these comments, Im worried it can make my hearing worse. Should I quit taking it or just use it as I need it? My ear has a rushing noise in it now. Im hoping thats only because it still has fluid. Thank you for your info.
Hi Liz:
Fluticasone is mildly to moderately ototoxic so the less you use it, the less the chances of having any ototoxic side effects. I think the sensible way is like you said, “use it as I need it”.
The rushing noise is one of the many sounds of tinnitus. Fluticasone causes tinnitus and hearing loss in numbers of people, so you want to be careful.
Cordially,
Neil
Hi Dr. Neil Bauman,
My ENT doctor prescribed fluticasone nasal drops (Flixonase Nasule Drops) for my chronic rhinitis. I was on high dosage (400 mcg twice a day) for 4 days and then developed tinnitus. The doctor denied any possible link between tinnitus and fluticasone. But this is my first time having tinnitus and I don’t see any other obvious cause. Because the drops have to be taken when lying with head dangling upside down, could it be possible for the medicine to directly reach my ears from the nasal cavity?
I stopped the medicine 3 days ago, but my tinnitus is still ongoing. My hearing test today was normal, but it only tested up to 8000 Hz. My tinnitus is a high-pitched hissing sound (like a running computer) and is unilateral, and according to some sources it could be due to hearing loss in the high frequencies that are not tested. If it was caused by fluticasone, will it ever go away? What can I do now?
Thanks for the information on your website.
Hi Michael:
Your doctor is pretty ignorant about the side effects of the drugs he prescribes, isn’t he? If he had bothered to check the FDAs database he would have discovered that hundreds upon hundreds of people have reported getting tinnitus from taking this drug, and hundreds upon hundreds more reported hearing loss from taking this same drug. And this is only the tip of the iceberg because less than 1% of side effects are ever reported to the database according to a former FDA commissioner. Thus the true figure is at a minimum way up in the 6 figures, and that’s a lot of people.
I don’t have much information as to the permanency of tinnitus from taking Fluticasone. Hopefully, it will fade away in time–but I’d give it at least two weeks to see if it is slowly getting softer, but it could take months.
One thing you can try is to take N-acetyl-cysteine (NAC) which helps your body to make its powerful anti-oxidant–Glutathione. Since the result of drug damage to the inner ear is the formation of a lot of free radicals than zap the hair cells, if you take NAC, the resulting glutathione can zap these free radicals before they zap the hair cells and cause hearing loss. You have to do this right away before the free radicals do their damage. You can get NAC at health food stores and on-line. You don’t need a prescription. If it were me, I’d take at least 1,800 mg per day for at least two weeks.
Cordially,
Neil
An ENT dr. prescribed Afrin for 3 days to see if it would clear my clogged (left) ear. On the 3rd morning I was completely deaf for hours. And since then, my non-clogged (Right) ear lost 1/2 of its volume & had very thin sound. How could 3 days of Afrin cause so much loss to my good Right ear?
Hi Judy:
Oxymetazoline (Afrin) is a decongestant that shrinks blood vessels in your nasal passages. If it get absorbed into your blood stream and carried to your inner ears, it could do the same thing to the tiny blood vessels in your cochlea. As a result of reduced blood flow there, it could cause temporary hearing loss. This is what I think could have happened in your case.
Probably you shouldn’t use this drug in the future.
Cordially,
Neil
Hi Neil,
My tinnitus started in may after noise exposure to a live show I attended. It started with mechanical clicking in right ear, three ENT doctora found nothing and performed all tests, even OAE, then it started with static sound in left ear. I also developed reactive tinnitus to my left ear. It had stabilized for 2 and 1/2 months but now has returned even worse. I’m careful not to attend very noisy places and I’ve never been to another concert since may. I visited a neurologist to see if they can find another cause of the issue and prescribed me betahistine, along with Gingko biloba, vitamin d ( I have great deficiency) and mirtazapine (antidepressant) for sleep. I use the antidepressant only for sleep , i used it once so fae and reduces tinnitus by 80%. I’m starting tomorrow what he suggested above, but I dont want to get disappointed once again. I’m thinking of getting hearing aids if all else fails. Let me know what you think, thanks so much.
Hi Mary:
This mechanical clicking sound you experienced, did it include a sensation of movement, like your ear drum was clicking, or was it just a sound with no “feeling” involved?
What sounds was your left ear reacting to? And what was the reaction like?
Ginkgo biloba and Vitamin D3 should not cause you problems (and don’t except in rare cases). When you say your vitamin D levels are very low, how low is that? The minimum should be 40 ng/ml and optimally it should range between 60 and 80 ng/ml. A vitamin D deficiency can affect around 2,000 different genes–so it can cause all sorts of problems in your body.
Go easy on the Mirtazapine but taking it occasionally should be ok in most cases.
Why would you consider getting hearing aids–do you have a significant hearing loss? Or was it just for helping with your tinnitus?
Cordially,
Neil
Hi Neil,
Thanks for your response, I’ll try to reply in as much detail as possible:
The mechanical – clicking sound seemed to follow a pattern and was acompanied by a fluttering sensation in my ear at times. However the fluttering sensation was not following the pattern of the sound at all, it was random. Now instead of clicking I hear a very distant repetitive beeping noise, like some sort of scanning/laser machine. It sounds like a pinball game if that makes sense. No fluttering. The clicking acompanied the beeping noise as well until a few days ago. I have 2-3 sounds in my right ear that seem to come and go but persist. These noises were completely missing for two months and I was simply left with a generic static noise. I was positive that things were getting better.
About my left ear: it reacts when I’m scratching my head, or use a plastic brush (it makes a particular sound), or typing on keyboard mostly. This triggers a soft hissing/static sound that remains for a while. It tends to sound more ” electrified” compared to my right side. I’m unsure about sensitivity in my right ear. Each ear seems to be acting differently.
My vitamin D levels are 9ng/ml at the moment. I live in a Mediterranean country so that is kind of a paradox. I rarely go outside due to lack of interest for anything else except tinnitus and how to deal with it.
In regards to the hearing aids, I was informed that people with tinnitus or sound sensitivity may benefit from them or sound therapy through hearing aids. Unfortunately they’re pretty expensive and since I don’t have hearing loss (at least nothing detectable so far) , I’m not sure if its worth it.
I’m holding onto mirtazapine for difficult times as I occasionally have trouble sleeping. My environment is pretty stressful. I’m only 32 years old.
Thanks for any additional info or advice, I truly appreciate it.
(Fun fact : the beeping suddenly seems louder now that I mentioned it).
Hi Mary:
I think the fluttering sound/feeling was due to sudden loud sounds at the concert–a startle reflex. Since it has now gone away, that is good news–your ears are calming down in that respect.
I wouldn’t worry about your reactive tinnitus at this point. I think it will go away in time as your nerves (and yourself) calm down.
You NEED to get your vitamin D3 levels up. That low a level can cause various problems that higher levels will ameliorate. The optimal level would be 70 ng/ml. You should get out in the sun more and naturally build up your D3 levels as well as take supplements. You’ll feel better too.
Instead of buying expensive hearing aids or sound generators, you can use other sound sources for sound therapy. For example, you can listen to white or pink noise, fractal music, natural environmental sounds or water sounds that you can download and stream from your cell phone and listen to via earbuds or headphones. Set the volume so that it is just a bit lower than the sound of your tinnitus (where the two sounds mix together). That can help you as much as fancy hearing aids or sound generators can.
I think your real problem is anxiety. That can result in all kinds of tinnitus sounds. You need to learn how to relax. Practice relaxation exercises that you can find on the internet. Ditto for relaxing breathing exercises. You can do breathing exercises almost anywhere and at any time that will help you calm down immediately. A very simple, yet effective, one is to breathe in to the count of four, hold your breath to the count of four, breathe out to the count of four, hold your breath for the count of four–and repeat this for 5 to 10 minutes or so at a time and see how much calmer you are when you do this. Do this during the day (or night) as often as necessary to remain calmer.
Whenever you think about or talk about or write about your tinnitus, it typically gets louder temporarily. This happens to me and my tinnitus every day whenever I think about tinnitus–like right now. My tinnitus is pretty loud at the moment, but just before I began writing this to you I wasn’t even aware of my tinnitus.
The good news is that I am so habituated to my tinnitus that within five minutes from completing this response, I won’t be hearing my tinnitus anymore.
The secret is to treat your tinnitus as a totally unimportant background sound that is safe to ignore, then ignore it by focusing on the loves of your life.
On the other hand, if you treat your tinnitus as a threat to your well-being in any way, your limbic system will continue to bring it to your attention and make it even louder (and this is exactly what you don’t want). Yet this is what I think you are doing.
Practice doing the former rather than the latter and see how much difference it makes to your life.
Cordially,
Neil
Hi Neil,
You’re right especially about the anxiety. Unfortunately I’ve been suffering from anxiety for years and tinnitus was definitely not something I could handle at this time. I’ll focus on increasing D3 as well, I asked my doctor about it but surprisingly they didn’t seem to worry that much about it! Thanks again for your kind help.
Hello dr.Neil,
I was wondering if hearing tests can also worsen tinnitus or hyperacusis, except of ototoxic drugs.
I have tinnitus and mild hyperacusis after noise exposure but I’ve been tested multiple times by different ENTs since then and found no explanation.
Earlier today I visited a hearing aid center where an audiologist evaluated my condition. We discussed some options for sound therapy, and I specifically asked them not to perform any loud tests on me. They agreed and only did an audiogram with spongy earplugs in my ears, then a bone conduction test with a headband attached at the back of my head and played very low sounds, during both tests, bearly audible. Nothing loud or too invasive. Is it possible that these tests have caused any damage or will exaggerate my problem or trigger worse hyperacusis? I’m a bit anxious as time goes by as I’m not quite sure how the bone conduction thing worked, but sending a signal to the nerve (as described by the audiologist) sounds too scary to me. I am not aware of how frequently these tests are performed and if they’re something to avoid if you got noise sensitivity.
Thanks in advance for any information you can provide on this matter.
Hi Minnie:
Found no explanation for what–your tinnitus and hyperacusis? You just gave the answer–from noise exposure, or am I missing something?
The basic test that can cause tinnitus or hyperacusis to become worse is called the Uncomfortable Loudness Level test (UCL). This test seeks to find the loudest sound you can stand. If you have tinnitus or especially loudness hyperacusis, this can make things worse, so you may want to pass on this test.
In contrast, the pure tone testing seeks to discover the softest sound you can hear. This test should not bother your tinnitus or hyperacusis as the sounds are kept soft.
Bone conduction is no more dangerous to your ears than pure tone testing, because again, they keep the sound levels soft. Remember, the test is to see how soft a sound you can hear, not how loud a sound you can stand.
Cordially,
Neil